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Requiring proof of citizenship cuts participation in Oregon's Medicaid family planning program

Research Activities, September 2010, No. 361

To combat Medicaid fraud by noncitizens, proof of citizenship has been a requirement for Medicaid eligibility since implementation of the Federal Deficit Reduction Act (FDRA), effective November 1, 2006. This requirement reduced family planning visits by a third under the Medicaid-funded Oregon Family Planning Expansion Project, according to a new study. However, the requirement did not affect visit differences by Hispanics and non-Hispanics, which were both down by about a third. This casts doubt on the need for proof of citizenship to combat Medicaid fraud by noncitizens, note the authors of the study. They also found that the citizenship requirement did reduce access to family planning services and preventive health care for thousands of families in Oregon. The Deficit Act also required teenage Medicaid applicants to provide their Social Security numbers, and applicants with other insurance were no longer eligible for services under the program.

The Oregon researchers found that, during the study period, 61 percent of 698,832 family planning visits to State-funded clinics were billed to the Family Planning Expansion Project. Clients under age 20 accounted for 29 percent of all the visits, with clients aged 20-24 accounting for another 34 percent. The vast majority of services (97 percent) were sought by women, though the program was open to both sexes. While 21 percent of the visits were by Hispanic patients, Hispanic patients represented only 9 percent of visits billed to the project. White patients accounted for 82 percent of the visits and 74 percent of the clients had below-poverty incomes.

When the researchers compared Family Planning Expansion Project visits 18 months after the Deficit Act took effect with those in the 18 months prior to its implementation, they found a decline of 33 percent, but a decline of only 10 percent for visits not billed to the project. Once the law took effect, visits by clients under age 18 declined by 46 percent, but by only 30 percent for clients aged 18 and older. The researchers collected data on use of family planning services from the Oregon Public Health Division from May 1, 2005, through April 30, 2008. Using these data, the researchers compared visit volume and demographic characteristics of clients before and after the change in requirements. The study was funded in part by the Agency for Healthcare Research and Quality (HS16181).

More details are in "Evidence that the Citizenship Mandate curtailed participation in Oregon's Medicaid Family Planning program," by Lisa Angus, M.P.H., and Jennifer DeVoe, M.D., D.Phil., in the April 2010 Health Affairs 29(4), pp. 690-698.